Sunday, January 21, 2018

Supporting children with special needs requires individualized and effective intervention
strategies. It is very important for families, teachers, administrators, and
school-based support personnel to be knowledgeable about evidence-based
approaches to adequately
address these unique needs and help
minimize the gap between research and practice. An evidence-based practice can
be defined as a strategy, intervention, treatment, or teaching program that has
met rigorous peer review and other standards and has a history of producing
consistent positive results when experimentally tested and published in
peer-reviewed professional journals. The success of an intervention depends on
the interaction between the age of the child, his or her developmental level
and individual characteristics, strength of the intervention, competency of the
professional, and a critical component termed treatment integrity.

Treatment
Integrity

Treatment integrity, also referred to as treatment
fidelity, intervention integrity, procedural reliability, and implementationintegrity is defined as the accuracy
and consistency with which each part or step of a treatment or intervention
plan is implemented as intended. It is an important link between the use and
effectiveness of interventions in clinical and school settings, and one of the
key aspects of scientific investigation. Identifying an evidence-based intervention
or treatment is a necessary but insufficient provision for producing behavior
change. Knowing that an intervention is effective and understanding how to use
it does not guarantee its accurate implementation. For example, absent or weak
treatment effects might be the result of the poor integrity of interventions,
despite their demonstrated empirical support. As a result, even evidence-based based
interventions may fail. This can lead to erroneous conclusions regarding
treatment effectiveness. Low levels of treatment integrity also adversely
affect external validity (i.e., the degree to which the results from a study
can be generalized across people, settings, and behaviors) and the ability of
researchers to replicate the procedures and find comparable results. This can
have a negative effect on the development of effective interventions and
procedures. Assuring treatment integrity is critically important for
dissemination of evidence-based practices and the delivery of effective
services.

Treatment Integrity in
Research and Practice

Although the
importance of treatment validity has been recognized in the literature, this
construct has largely been ignored in research and practice. Unfortunately, the
measurement of treatment integrity tends to be more the exception than the
rule. Relatively few intervention
studies have monitored or systematically assessed treatment integrity. For example,
a review of published behavioral intervention research studies found that only
18% assessed and reported treatment integrity data. Similarly, a recent survey
of practicing certified school psychologists’ knowledge and use of treatment
integrity in academic and behavioral interventions found that while the
majority of participants believed that it is a critical component to the
development, monitoring, and evaluation of school-based interventions, only18%
of the participants consistently measured treatment integrity in a one-on-one
consultation, while just 4.6% of the participants consistently measured
treatment integrity within a school-based problem-solving team. It appears that
treatment integrity is more often assumed rather than evaluated and empirically
documented. This reliance on a ‘consult and hope’ strategy (consult and hope
the intervention is implemented with as planned) is troublesome in that it
impedes our ability to establish functional relationships between treatments
and outcomes. The measurement of treatment integrity is essential
when evaluating school-based interventions not only for children with ASD, but for all students with academic, behavior, and developmental concerns. Without information regarding treatment integrity, practitioners
have little idea as to whether their intervention plans are effective. Clearly,
establishing the integrity of treatments should be regarded as a critical
aspect of practice and research.

Monitoring Treatment Integrity

A consistent finding in the literature is that
higher levels of treatment integrity are associated with better outcomes. Thus,
it is essential that treatment integrity information be collected when
implementing interventions so as to distinguish between ineffective
interventions and potentially effective treatments implemented with poor
integrity. While implementing intervention procedures with textbook accuracy
consistently in “real-world” settings presents a challenge, practitioners should
attempt to implement procedures with high levels of integrity as often as
possible. Direct and indirect methods can be used to document the extent to
which behavioral interventions agreed upon during consultation are being
implemented as intended by the change agent (e.g. teacher or parent). Although systematic observation is the most direct means of assessing treatment
integrity, this procedure is vulnerable to reactivity effects and tends to be a
labor-intensive activity, which is not always possible given the time
constraints and logistical problems encountered in most practice settings.
There are, however, less direct methods that can be utilized to monitor the
integrity of intervention plans. They include: (a) self-reporting;
(b) permanent products; (c) behavioral interviews; and (d)
performance feedback.While these methods are
less intrusive, they tend to be less accurate because they rely primarily on
self-reports. The social
significance of intervention outcomes or social validity is also of critical
importance. Consumers must feel assured that the selected intervention
strategies are effective and appropriate, and that the social objectives are
important to achieve. If the intervention lacks social validity, they are less
likely to apply the effort necessary to implement the intervention, thus
reducing intervention fidelity. Educators, parents and families expect (and
hope) that research will produce interventions and treatments that will improve
quality of life of children. Thus, the measurement of treatment integrity and
social validity should be a standard feature of intervention practice and
research.

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